谵妄评估工具在老年痴呆患者中的应用比较

Comparison of delirium assessment tool used in the old dementia patients

目的 比较谵妄评定方法（CAM）与护士用谵妄筛查量表（NU-DESC）在老年痴呆患者中应用的诊断效度.方法 符合DSM-Ⅳ痴呆诊断标准的患者,于入院后0、2、4、6、8周使用CAM、NU-DESC评估,以DSM-Ⅳ谵妄诊断标准为金标准,使用ROC曲线分析及诊断一致性检验,比较两种评估工具的诊断敏感性、特异性及一致性系数.结果 CAM判断痴呆患者发生谵妄的最佳临界值为26分,敏感性0.97,特异性0.82,与DSM-Ⅳ诊断一致性Kappa值为0.60;NU-DESC最佳临界值3分,敏感性0.81,特异性0.77,与DSM-Ⅳ诊断一致性Kappa值为0.45.对轻、中度痴呆患者,两种工具的诊断效度接近;对重度痴呆患者CAM诊断效度优于NU-DESC.结论 CAM在痴呆患者中使用的总体敏感性、特异性较高,优于NU-DESC,可作为痴呆患者伴发谵妄的筛查工具;NU-DESC适用于轻、中度痴呆患者的评估.

Objective To compare the diagnostic validity between the delirium rating methods （confusion assessment method,CAM） and the nurse used delirium screening scale（nursing delirium screening scale,NU-DESC）for the old dementia patients. Methods Patients who met the criteria for DSM-IV dementia diagnosis,the CAM and the NU-DESC was used to assess at 0,2,4,6,8 weeks after admission,and the DSM-IV was used as the gold standard diagnosis criteria for delirium. To compare the diagnostic sensitivity, specificity and consistency between the two evaluation tools using the ROC curve analysis and diagnostic consistency test. Results The criticality value of the CAM to estimate dementia patients with delirium was 26,with sensitivity 0.97,specificity 0.82,and the Kappa of the consistent with DSM-IV diagnosis was 0.60;the criticality value of the NU-DESC to estimate dementia patients with delirium was 3,with sensitivity 0.81, specificity 0.77,and the Kappa of the consistent with DSM-IV diagnosis was 0.45. For mild and moderate dementia patients,the diagnostic validity of the two tools was closer;for the severe dementia patients,the diagnostic validity of the CAM was better than the NU-DESC. Conclusions The sensitivity and specificity of the CAM used in the dementia patients were higher,the CAM was better than the NU-DESC,and could be used to screen for senile dementia patients with delirium;the NU-DESC could be used to estimate the mild and moderate dementia patients.